Company :Highmark Inc.
Job Description :
This job is responsible for supporting current pharmacy accounts, and assisting efforts to gain new pharmacy business. Responsibilities include supporting Sales Consultants with reporting, preparation of presentations, and data analysis support. This job also supports both the Sales and Pharmacy department with issue resolution, benefit consultation and utilization strategies, as well as implementation of new group benefits and support of and current group benefit changes. The incumbent's responsibilities include, but are not limited to Commercial, Specialty, and Medicare pharmacy benefits. This job performs complex analysis of claims and cost-based and risk management projects that will ensure proper alignment of benefit designs pertaining to the use and coverage of prescription drugs. The incumbent performs advanced research, problem identification, design and implementation oversight related to project management activities related to the activities listed above. Other duties include participating in the completion of all Prescription Drug Requests for Proposals, Requests for Information, surveys or other prescription drug informational requests; and developing and presenting training programs to internal staff, clients and producer organizations regarding the Prescription Drug Program.
- Support Sales Consultants with reporting, presentation, and data analysis needs.
- Track and follow up on account specific prescription drug issues ensuring issues are handled effectively, in a timely manner and report follow-up information to applicable parties. All issues will be documented within client business plans.
- Analyze and complete all Requests for Proposals, Requests for Information, surveys and any other prescription drug informational requests. Information presented will outline and emphasize the numerous pharmacy programs available, flexibility in benefit design options, pharmacy network options, formulary options and utilization management programs, to list a few of the areas of emphasis. Use the Pragmatech Proposal software package for completion of all informational requests to ensure quality improvement activity and compliance to ensure that department needs are met or exceeds corporate and regulatory agency expectations. Work with personal computers including presentation software, word-processing and spread sheet software.
- Provide benefit consultation and utilization strategies.
- Conduct complex analysis of claims in order to provide resolutions to benefit design questions, risk management projects, and other data analysis projects.
- Perform project management of new account implementations and support of current group benefit changes.
- Actively participate in the design and implementation of new pharmacy programs. Programs may include the following, but not limited to: utilization initiatives, pharmacy network initiatives, new benefit design initiatives and new product development.
- Other duties as assigned or requested.
- High School Diploma/GED
- Bachelor's Degree
- 3 years of experience in Managed care
- 2 years of experience in an analytical role (e.g. Financial or Data Analyst)
- 1 year of experience in Sales or Account administration
- 1 year of experience in Project Management
- Querying relational databases such as: SAS, SQL, etc.
- Strong Microsoft Excel Skills
- Responding to RFP's
- Strong Financial Analysis experience
- Reporting data in PowerPoint format
- Being first contact for client
- Excellent Written Communication Skills
- Strong troubleshooting and ability to work with a sense of urgency
SCOPE OF RESPONSIBILITY
Does this role supervise/manage other employees?
Is Travel Required?
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
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